Lower back pain indicates a disease or damage to the spinal column, nervous structures, soft tissues, internal organs, observed in febrile conditions of various origins. It can be acute, dull, constant, intermittent, burning, shooting, bursting. Sometimes associated with physical activity, weather changes. Pathologies that manifest as back pain are diagnosed on the basis of complaints, anamnesis, examination data and additional studies: radiography, MRI, CT. Before making a diagnosis, rest is necessary, sometimes it is acceptable to use ointments, taking analgesics.
A common cause of back pain is congenital anomalies and acquired diseases of the spinal column. The nature of the pain syndrome varies. Pain caused directly by the pathological process, often periodic, local, aching or pulling, associated with the weather, physical activity, being in an uncomfortable position.
Due to muscle spasm, lumbago (lumbago) occurs - a sharp pain, accompanied by restriction of movement. With many pathologies of the spine, lumboischialgia is observed - aching, burning or shooting pain in the lower back, radiating along the back of the thigh. Painful sensations are often found as part of the radicular syndrome. Can be detected in the following diseases of the spinal column:
Insignificant or moderate aching pains are noted with all types of curvature of the spinal column, which is associated with non-physiological redistribution of the load, overstrain of the muscles and ligaments of the back. Soreness appears due to an uncomfortable position of the body, sleeping on a bed that is too hard or too soft. Symptoms are accompanied by:
Lower back pain
Pulling or aching pain in the lumbar and thoracic spine for a long time is the only symptom of osteoporosis. The pain syndrome is expressed slightly, increases after exercise, before changing weather conditions. The symptom is observed in the following varieties of osteoporosis:
Similar pains are detected in patients with secondary forms of pathology caused by genetic diseases, endocrine disorders, chronic intoxications, and taking certain medications. Secondary osteoporosis can also occur against the background of malabsorption syndrome, liver disease, CRF, rheumatoid arthritis, SLE.
Increased soreness, an increase in the duration of pain may be associated with the development of a pathological fracture. Other signs of injury are often not expressed, so the fracture often remains undiagnosed.
The most common injury is spinal contusion. In mild cases, the pathology is manifested by moderate back pain, aggravated by movement, local edema, and sometimes hematomas and hemorrhages. In severe bruises, neurological disorders are added to the listed symptoms.
A compression fracture of the lumbar spine occurs due to forced flexion of the torso. It is characterized by sharp pain, breath holding at the time of injury. Then there is an increase in pain when turning the body, swelling of the soft tissues is detected. Palpation of the spinous process is painful. Other possible fractures include damage to the arches, transverse processes, spinous processes.
In addition, low back pain is found in patients with traumatic spondylolisthesis and vertebral subluxation. Painful sensations are paroxysmal, reminiscent of lumbago, complemented by a feeling of heaviness and numbness of the lower extremities.
Bruising of soft tissues is accompanied by slight or moderate, rapidly subsiding local pain, slight swelling. Hemorrhages are possible. There is no admixture of blood in the urine. Kidney bruises are manifested by soreness and slight short-term hematuria. With kidney injuries of moderate severity, the pain syndrome is intense, pain radiates to the lower abdomen, groin, and genitals. A hematoma is visible in the lumbar region. In severe cases, there is severe pain, prolonged gross hematuria. Shock develops.
Osteomyelitis of the spine can be hematogenous, post-traumatic, contact, postoperative. The acute form of the disease is manifested by rapidly increasing pain in the lower back, combined with chills, fever, intoxication syndrome, deterioration of the general condition. The pains are jerking, bursting, so intense that they interfere with any movement, forcing the patient to freeze in bed. In chronic osteomyelitis, the manifestations are smoothed out, a fistulous tract with purulent discharge is formed.
Tuberculosis of the spinal column develops gradually. Initially, periodic deep pains are observed, aggravated after exercise, increased sensitivity of the skin in the projection of the affected vertebrae. Stiffness of gait is formed. Against the background of significant destruction of bone structures, the nature of the pain changes, since it is caused by compression of the nerve roots. The pains become burning, radiate to the legs, are supplemented by paresthesias, numbness.
In patients with spinal epidural abscess, the pain is severe, deep, diffuse, combined with chills, hyperthermia, and muscle tension. Tapping on the spinous processes of the vertebrae is painful. With the progression of the pathology, a radicular syndrome occurs, then paresis, disturbances in the activity of the pelvic organs develop.
Purulent processes in the superficial tissues and perirenal tissue are accompanied by intense pain in the lower back. Possible causes of pain are boils, carbuncles and paranephritis.
In the first two cases, an abscess is formed in the skin, looks like a limited, sharply painful seal with a diameter of 1 cm or more of a purple or purple-bluish hue with one or more rods in the center. The pain quickly increases, becomes twitching, throbbing, sleep depriving. General hyperthermia, slight or moderate disturbance of the general condition are noted.
With paranephritis, severe fever first occurs. The pain syndrome develops in 2-3 days. The pain is very intense, can be given to the stomach or hypochondrium, aggravated by walking, movement, deep breathing. In some forms of paranephritis, the patient takes a forced position due to pain. The lumbar muscles are tense. Edema, local hyperemia, hyperthermia are revealed. Severe condition.
Diffuse aching pain in the lower back, causing a desire to change the position of the body, is characteristic of acute infections, accompanied by fever and intoxication syndrome. In most cases, due to myositis, often combined with pain in the muscles of the limbs. Observed with influenza, tonsillitis, SARS. Sometimes pain is provoked by kidney damage. Infectious diseases accompanied by pain in the lumbar region include:
In a number of patients, low back pain is observed during a cytokine storm, an inflammatory reaction that develops against the background of severe infectious diseases. Epidemiological myalgia is accompanied by intense paroxysmal pains lasting up to 1 minute, which appear not only in the lower back, but also in other parts of the back, in the area of the abdominal wall, chest, limbs. Repeated with an interval of 30-6 minutes. Combined with rhinitis, conjunctivitis, severe hyperthermia.
Aching pain in the muscles of the lumbar region is determined after intense physical exertion - performing strength exercises for the muscles of the back, prolonged stay in a forced position with a tense lower back. Myalgia subsides at rest, increases with movement, weakens after warming, gentle warm-up, disappears after a few days.
Myositis develops not only in infectious diseases, but also after hypothermia or overload, against the background of exogenous intoxication, metabolic disorders. Accompanied by prolonged aching pain. There are also special forms of myositis:
Chronic diffuse pain throughout the body, including the lower back, is seen in fibromyalgia. Combined with sleep disorders, asthenia, neurotic disorders.
In addition to the listed pathologies, back pain can be disturbing in conditions such as:
In diseases of the small pelvis, irradiation of pain in the lower back is sometimes noted. The appearance of a symptom is possible with a number of female diseases, prostate cancer, proctitis, sigmoiditis.
Primary diagnosis is carried out by an orthopedic traumatologist. In the presence of neurological symptoms, the patient is examined by a neurologist. The doctor interrogates the patient, carries out an objective examination. According to indications, consultations of a surgeon, rheumatologist, urologist, and other specialists are prescribed. The diagnostic program may include:
According to indications, ultrasound of the kidneys, prostate, pelvic organs, urine tests, ultrasound of the abdominal aorta, and other studies are performed.
Manual therapy
In case of traumatic injury to the spine, it is necessary to lay the patient on a shield and immediately deliver to a medical facility. With non-traumatic pain, you should reduce the load on the back, optimize the position of the body during work and rest. Acute pain syndrome is an indication for consultation with a neurologist.
Prior to the examination by a specialist, a single dose of analgesics is possible. With lumbago, lumboischialgia, caused by previously diagnosed degenerative diseases of the spine, the use of local warming and analgesic drugs is allowed. If an infectious process is suspected, local remedies are not indicated.
The basis of treatment is physiotherapy and drug therapy. The patient is assigned a protective regimen. The following methods are applied:
Taking into account the characteristics of the pathology, the following surgical interventions are carried out:
In the postoperative period, analgesics and antibiotics are prescribed. Rehabilitation activities include exercise therapy, massage, physiotherapy.